Neighborhood Socioeconomic Status and Heart Failure or All-Cause Readmission Within a Municipal Hospital System

Abstract

Background Neighborhood socioeconomic status (nSES) is associated with heart failure (HF) outcomes but has not been investigated within a municipal public health system. Objectives The authors assessed the relationships between nSES index and HF-specific or all-cause hospital readmissions and all-cause mortality. Methods We conducted a retrospective electronic medical record-based cohort study of adults with International Classification of Diseases-9 or -10 diagnosis of HF; geocoded residential address; and index HF admission within a municipal public health system between January 2001 and September 2019. Kaplan-Meier analyses were used for time-to-event analyses. Fine-Gray Survival models were adjusted for demographics, comorbidities, substance use, guideline-directed medical therapy, and 30-day outpatient follow-up with random effects to account for correlation within census tracts. Results Among 2,440 individuals, the median age was 60.8 years (SD 14.8 years), 33.6% (821/2,440) were females, and 35.7% (870/2,440) self-identified as Black. The median follow-up time was 38.1 months (IQR: 16.2-74.1 months). The lowest nSES quintile had a 62% higher HF readmission risk (HR: 1.62; 95% CI: 1.09 to 2.41; P = 0.018) and 54% higher all-cause readmission risk (HR: 1.54; 95% CI: 1.17-2.02; P = 0.002) over 1 year than the highest nSES quintile. nSES was not associated with all-cause mortality. Geographic “hotspots” of index HF hospitalizations or all-cause readmissions occurred in neighborhoods disproportionately affected by historical redlining policies and single-room occupancy units. Conclusions Lower nSES is associated with higher HF-specific and all-cause readmission within a municipal hospital system. Future research should focus on improving HF morbidity for readmission “hotspot” neighborhoods.